Intrathecal bupivacaine or levobupivacaine: Which should be used for elderly patients?

Abstract

Objectives: To compare two intrathecal anaesthetics, bupivacaine and levobupivacaine, for their effects on motor and sensory blockade and haemodynamics in patients aged !65 years undergoing transurethral resection of the prostate (TUR-P) or transurethral resection of the urinary bladder (TUR-M). Methods: Patients scheduled to undergo TUR-P or TUR-M were randomized to receive either 3 ml (15 mg) 0.5% isobaric levobupivacaine (group L) or 3 ml (15 mg) of 0.5% hyperbaric bupivacaine (group B) for spinal anaesthesia. The onset time, maximum level and time to reach the maximum level of sensory and motor blockade were recorded. Changes to haemodynamic parameters were also recorded. Results: The study randomized 100 patients: 57 to group L and 43 to group B. Levobupivacaine did not cause any significant changes in haemodynamic parameters, including systolic blood pressure, and showed a similar sensory block onset time compared with bupivacaine, but it had a significantly longer motor block onset time compared with bupivacaine. Conclusion: These current findings suggest that levobupivacaine can be used as a substitute for bupivacaine for spinal anaesthesia in elderly patients !65 years of age undergoing elective TUR-P or TUR-M operations.

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

“…In our series of TCSA procedures, we reinforced the findings that the 2 local anesthetics, levo-bupivacaine and bupivacaine, are clinically comparable in terms of efficacy, potency, and hemodynamic response, as several studies have indicated during lumbar spinal anesthesia [ 37 , 38 ], lacking definitive assumptions on the superiority of one over the other. Nevertheless, we identified a discrepancy in the cumulative dose of neuraxial local anesthetic used in the 2 groups, with a greater amount of drug consumed in the LA + M + K group.…”

Predictors of hypotension during surgical management of femoral fractures in spinal anesthesia

“…However, in this research, the group of patients was very heterogeneous regarding the age, from 18 to 85 years [13]. Gulek et al established that there was no significant statistical difference between the type or dosage of the local anesthetic (bupivacaine and levopubivacaine) and arterial hypotension during spinal anesthesia in elderly patients [14]. By comparing the preoperative values of average arterial pressure and the values at the end of the SP, it was proved that the patients have higher preoperative MAP in relation to the last value of MAP during surgery.…”

Efficacy of Intrathecal Levobupivacaine and Bupivacaine for Caesarean Section- A Comparative Study

“…The levobupivacaine and ropivacaine are an interesting alternative to racemic bupivacaine. In a study on comparison of intrathecal 3.0 mL isobaric levobupivacaine with 3.0 mL hyperbaric bupivacaine in elderly patients undergoing TURP or TUR of urinary bladder, Gulec D et al [17] showed that levobupivacaine has statistically significant (p = 0.0001) longer onset of maximum motor block time (9.84 ± 3.10 minutes) as compared to bupivacaine (6.49 ± 2.2 minutes). Erdil F et al [11] in their study on the effects of intrathecal levobupivacaine and bupivacaine in 80 elderly patients, came to the conclusion that although the degree of motor block was similar in both the groups, the time to maximum motor block was 19.1 ± 5.4 minutes in levobupivacaine group while it was 9.5 ± 4.2 minutes in bupivacaine group proving statistically significant longer onset of maximum motor block with levobupivacaine.…”